Therapeutic optimism can be achieved with the use of specially adapted interventions and sophisticated clinical supervision, says Gemma King

Despite significant changes to policy, legislation and treatment pathways for people with borderline personality disorder in recent years, stigma and prejudice towards this client group remain ingrained in mental health services.

This article explores the notion of therapeutic pessimism and other possible reasons why attitudes remain unchanged. In considering the benefits of dialectical behaviour therapy for those with borderline personality disorder, it offers suggestions for improving service provision and for developing a more optimistic approach to care.